Jared Bierbrier, Emily Gerstein, G A Whitmore, Katherine L Vandemheen, Celine Bergeron, Louis-Philippe Boulet, Andreanne Cote, Stephen K Field, Erika Penz, R Andrew McIvor, Catherine Lemière, Samir Gupta, Paul Hernandez, Irvin Mayers, Mohit Bhutani, M Diane Lougheed, Christopher J Licskai, Tanweer Azher, Nicole Ezer, Martha Ainslie, Gonzalo G Alvarez, Sunita Mulpuru, Shawn D Aaron
{"title":"呼吸困难对无明确诊断的成人呼吸道症状的影响。","authors":"Jared Bierbrier, Emily Gerstein, G A Whitmore, Katherine L Vandemheen, Celine Bergeron, Louis-Philippe Boulet, Andreanne Cote, Stephen K Field, Erika Penz, R Andrew McIvor, Catherine Lemière, Samir Gupta, Paul Hernandez, Irvin Mayers, Mohit Bhutani, M Diane Lougheed, Christopher J Licskai, Tanweer Azher, Nicole Ezer, Martha Ainslie, Gonzalo G Alvarez, Sunita Mulpuru, Shawn D Aaron","doi":"10.1016/j.chest.2024.07.183","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>We investigated dyspnea, its associated risk factors, and its impact on healthcare utilization, quality of life, and work productivity in adults with undiagnosed respiratory symptoms.</p><p><strong>Research question: </strong>What is the impact of dyspnea in adults with undiagnosed respiratory symptoms?</p><p><strong>Study design and methods: </strong>This population-based study included 2857 adults who were experiencing respiratory symptoms. These individuals had not been previously diagnosed with any lung conditions and were recruited from 17 Canadian centers using random digit-dialing. Each participant underwent spirometry testing both before and after using a bronchodilator to determine if they met the diagnostic criteria for COPD, asthma, Preserved Ratio Impaired Spirometry (PRISm), or if their spirometry results were normal. An age-matched control group (n= 231) was similarly recruited using random-digit dialing. A dyspnea impact assessment score from 0 to 100 was produced using questions from the COPD Assessment Test and St. George's Respiratory Questionnaire.</p><p><strong>Results: </strong>Individuals with PRISm (n=172) reported more impactful dyspnea (mean score 63.0, 95% CI: 59.5- 66.4) than those with undiagnosed asthma (n=265, mean score 56.6, 95% CI: 53.9-59.3) or undiagnosed COPD (n=330, mean score 57.5, 95% CI: 55.1-59.9). All groups reported significantly more impactful dyspnea compared to controls (mean score 13.8, 95% CI:11.8-15.7). Subject-specific risk factors including age, sex, BMI, smoking, and comorbidities explained 20.6% of the variation in dyspnea. An additional 12.4% of the variation was explained by disease classification and another 1.7% by the severity of lung function impairment assessed with spirometry. After adjusting for age, sex, and BMI, greater dyspnea impact was associated with increased healthcare utilization, lower quality of life, and reduced work productivity.</p><p><strong>Interpretation: </strong>In community-based adults with undiagnosed respiratory symptoms, those identified with PRISm experienced the greatest impact of dyspnea. 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These individuals had not been previously diagnosed with any lung conditions and were recruited from 17 Canadian centers using random digit-dialing. Each participant underwent spirometry testing both before and after using a bronchodilator to determine if they met the diagnostic criteria for COPD, asthma, Preserved Ratio Impaired Spirometry (PRISm), or if their spirometry results were normal. An age-matched control group (n= 231) was similarly recruited using random-digit dialing. A dyspnea impact assessment score from 0 to 100 was produced using questions from the COPD Assessment Test and St. George's Respiratory Questionnaire.</p><p><strong>Results: </strong>Individuals with PRISm (n=172) reported more impactful dyspnea (mean score 63.0, 95% CI: 59.5- 66.4) than those with undiagnosed asthma (n=265, mean score 56.6, 95% CI: 53.9-59.3) or undiagnosed COPD (n=330, mean score 57.5, 95% CI: 55.1-59.9). 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Impact of Dyspnea on Adults with Respiratory Symptoms Without a Defined Diagnosis.
Background: We investigated dyspnea, its associated risk factors, and its impact on healthcare utilization, quality of life, and work productivity in adults with undiagnosed respiratory symptoms.
Research question: What is the impact of dyspnea in adults with undiagnosed respiratory symptoms?
Study design and methods: This population-based study included 2857 adults who were experiencing respiratory symptoms. These individuals had not been previously diagnosed with any lung conditions and were recruited from 17 Canadian centers using random digit-dialing. Each participant underwent spirometry testing both before and after using a bronchodilator to determine if they met the diagnostic criteria for COPD, asthma, Preserved Ratio Impaired Spirometry (PRISm), or if their spirometry results were normal. An age-matched control group (n= 231) was similarly recruited using random-digit dialing. A dyspnea impact assessment score from 0 to 100 was produced using questions from the COPD Assessment Test and St. George's Respiratory Questionnaire.
Results: Individuals with PRISm (n=172) reported more impactful dyspnea (mean score 63.0, 95% CI: 59.5- 66.4) than those with undiagnosed asthma (n=265, mean score 56.6, 95% CI: 53.9-59.3) or undiagnosed COPD (n=330, mean score 57.5, 95% CI: 55.1-59.9). All groups reported significantly more impactful dyspnea compared to controls (mean score 13.8, 95% CI:11.8-15.7). Subject-specific risk factors including age, sex, BMI, smoking, and comorbidities explained 20.6% of the variation in dyspnea. An additional 12.4% of the variation was explained by disease classification and another 1.7% by the severity of lung function impairment assessed with spirometry. After adjusting for age, sex, and BMI, greater dyspnea impact was associated with increased healthcare utilization, lower quality of life, and reduced work productivity.
Interpretation: In community-based adults with undiagnosed respiratory symptoms, those identified with PRISm experienced the greatest impact of dyspnea. Dyspnea imposes burdens on the healthcare system and is associated with impaired quality of life and work productivity.
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At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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